Appendix C – Recognising Abuse Signs, Indicators and Types Of

Appendix C – Recognising Abuse Signs, indicators and types of abuse in Children and Adults It is important to remember that many children and adults will exhibit some of these signs and indicators at some time, and the presence of one or more should not be taken as proof that abuse is occurring. There may well be other reasons for changes in behaviour such as death, or the birth of a new baby in the family, relationship problems between parents/carers etc. However, you should always report anything that causes you to suspect that abuse may be happening in order for appropriate action to be taken to ensure the welfare and safety of children and adults. Within the relevant legislation and statutory guidance there are four known categories of abuse identified for children and ten categories of abuse noted for adults. Children and Adults Physical, emotional (or psychological), sexual and neglect. Adults Physical, emotional (or psychological), sexual, financial, discriminatory, institutional, domestic abuse, modern slavery, neglect and acts of omission and self neglect. Please note that the tabled examples and signs detailed below may also be indicators of other medical factors and may not necessarily confirm abuse and neglect. These tables are provided as a guide to help with the assessment process and the work with children, adults and their families. PHYSICAL ABUSE Examples include Signs include Shaking Unexplained bruising, marks or Pinching injuries on any part of the body Slapping Frequent visits to the GP or A&E Force-feeding An injury inconsistent with the Biting explanation offered Burning or Scalding. Fear of parents or carers being Causing needless physical approached for an explanation discomfort Aggressive behaviour or severe Inappropriate restraint temper outbursts Locking someone in a room Flinching when approached Reluctance to get changed or wearing long sleeves in hot weather Depression Withdrawn behaviour or other behaviour change Running away from home/ residential care Distrust of adults, particularly those with whom a close relationship would normally be expected EMOTIONAL/PSYCHOLOGICAL ABUSE Examples include Signs include Intimidation and/or threats A failure to thrive or grow Bullying Sudden speech disorders Rejection Developmental delay, either in terms Shouting of physical or emotional progress Indifference and the withdrawal of Behaviour change approval Being unable to play or socialise with Denial of choice others Deprivation of dignity or privacy Fear of making mistakes The denial of human and civil rights Self harm Harassment Fear of parent or carer being Being made to fear for one’s well approached regarding their being behaviour Confusion SEXUAL ABUSE Examples include Signs include Rape and other sexual offences Pain or itching in the genital/anal For adults, sexual activity including areas sexual contact and non-sexual Bruising or bleeding near genital/anal areas contact that the person does not Sexually transmitted disease want, to which they have not Vaginal discharge or infection consented, could not consent, or Stomach pains were pressured into consenting to. Discomfort when walking or sitting Being encouraged or enticed to touch down the abuser Pregnancy Coercing the victim into watching or Sudden or unexplained changes in participating in pornographic videos, behaviour, e.g. becoming aggressive photographs, or internet images or withdrawn Fear of being left with a specific Any sexual relationship that develops person or group of people where one is in a position of trust, Nightmares power or authority Leaving home Sexual knowledge which is beyond their age or development age Sexual drawings or language Bedwetting Saying they have secrets they cannot tell anyone about Self harm or mutilation, sometimes leading to suicide attempts Eating problems such as overeating or anorexia NEGLECT Examples include Signs include Withholding help or support Constant hunger, sometimes necessary to carry out daily living stealing food from others tasks Dirty or ‘smelly’ Loss of weight, or being constantly Ignoring medical and physical care underweight needs Inappropriate dress for the weather Failing to provide access to health, Complaining of being tired all the social or educational support time The withholding of medication, Not requesting medical assistance nutrition and heating and/or failing to attend appointments Having few friends Keeping someone in isolation. Worsening of health conditions Failure to intervene in situations that Pressure sores are dangerous to the person Mentioning their being left alone or Inadequate supervision and guidance unsupervised – leaving the child to cope alone, Sore or extreme nappy rash abandoning them or leaving them Skin infections with inappropriate carers and failing Lack of response to stimuli or to provide appropriate boundaries contact about behaviours such as under age Poor skin condition(s) Frozen watchfulness sex or alcohol. Anxiety Distressed Child moves away from parent under stress Little or no distress when separated from primary carer Inappropriate emotional responses Language delay Self –Neglect (Adults) Can sometimes be as a result of a person’s choice of lifestyle and covers a wide range of behaviour including: Examples include Signs include Little or no personal care poor grooming, dirty or ragged Refusing medication or refusing to clothes, unclean skin and fingernails stay on medication unwilling to accept medical care unable to focus, carry on normal Disorientated or incoherent conversation or answer basic Unsafe living conditions questions about date, place, and time Inability to manage finances and Lack of food or basic utilities in the property home, unclean living quarters, Isolation rodents or other vermin Hoarding when it becomes extreme Hoarding animals or trash, inability to (including animal hoarding). get rid of unneeded items Inability to manage finances and property: not paying bills, repeatedly In these circumstances there is no borrows money, gives money or abuser. property away Little contact with family or friends, no social support Living in grossly unsanitary conditions Suffering from untreated illness or disease/condition Suffering from over or under eating to the extent that if untreated the adult’s physical or mental health could be impaired Creating a hazardous situation that would likely cause serious physical harm to the adult or cause substantial loss of assets Adults may experience several other types of abuse as detailed below: FINANCIAL ABUSE (Adults) Examples include Signs include Being over charged for services Lack of basic requirements e.g. Being tricked into receiving goods or food, clothes, shelter services that they do not want or Inability to pay bills. need Unexplained withdrawals from Inappropriate use, exploitation, or accounts. misappropriation of property and/or Inconsistency between standard of utilities living and income Theft Reluctance to take up assistance Deception which is needed Fraud Unusual interest by family and other people in the person’s assets Exploitation or pressure in Recent changes in deeds connection with wills Power of Attorney obtained when person lacks capacity to make the decision. DISCRIMINATORY Examples Signs Use of inappropriate “nick names” Being treated unequally from other Use derogatory language or users in terms of the provision of terminology care, treatment or services Enforcing rules or procedures which Being isolated undermine the individual’s well being Derogatory language and attitude by Denial to follow one’s religion carers Lack of appropriate food Dismissive language by staff Denial of opportunity to develop Hate campaigns by neighbours or relationships others Denial of health care. Deteriorating health Indicators of other forms of abuse ORGANISATIONAL ABUSE Examples Signs Service users required to ‘fit in’ Inflexible daily routines, for example: excessively to the routine of the set bedtimes and/or deliberate service waking More than one individual is being Dirty clothing and bed linen neglected Lack of personal clothing and Everyone is treated in the same way possessions Other forms of abuse on an Inappropriate use of nursing and institutional scale medical procedures Lack of individualised care plans and failure to comply with care plans Inappropriate use of power, control, restriction or confinement Failure to access health care, dentistry services etc Inappropriate use of medication. Misuse of residents’ finances or communal finances Dangerous moving and handling practices Failure to record incidents or concerns Other types of abuse Staff should also have an awareness of the following other types of abuse: Domestic Violence and Abuse As of 1st March 2013, the Home Office definition of Domestic violence and abuse is: Any incident or pattern of incidents of controlling1, coercive2 or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse; psychological, physical, sexual, financial and/or emotional Source: www.homeoffice.gov.uk In all cases where there is knowledge or suspicion that there exists a potential for a child or children to be suffering harm as a result of domestic violence and abuse, then a referral should be made to Children’s

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